Kubota Asami, Murai Yasuo, Umezawa Hiroki, Ishisaka Eitaro, Tsukiyama Atsushi, Nakagawa Shunsuke, Matano Fumihiro, Ogawa Rei, Morita Akio
Department of Neurological Surgery, Nippon Medical School.
Department of Plastic, Reconstructive and Aesthetic Surgery, Nippon Medical School.
J Nippon Med Sch. 2019;86(4):248-253. doi: 10.1272/jnms.JNMS.2019_86-406.
Tumors of the skull base, such as meningiomas, tend to recur. With progress in free vascularized flap surgery, an increasing number of studies are investigating skull base reconstruction with free flaps after tumor removal. In this report, we discuss the results of second free flap surgery after skull base reconstructive surgery. We retrospectively analyzed data from patients treated at our center during the period from 2013 through 2017. All four patients identified had skull base anaplastic meningioma and had undergone radiotherapy. In all cases, the flap and donor blood vessel were sourced from sites that differed from those used in the previous surgeries. No complications developed, such as cerebrospinal fluid leakage, meningitis, wound infection, wound hemorrhage, or flap necrosis. Because the first flap was found to be unviable, it was difficult to preserve and was removed. Essential points in preventing complications are anchoring at the appropriate site, pinprick testing of the created flap, and use of multilayered countermeasures to prevent cerebrospinal fluid leakage.
颅底肿瘤，如脑膜瘤，往往会复发。随着游离血管化皮瓣手术的进展，越来越多的研究正在探讨肿瘤切除后用游离皮瓣进行颅底重建。在本报告中，我们讨论了颅底重建手术后第二次游离皮瓣手术的结果。我们回顾性分析了2013年至2017年期间在我们中心接受治疗的患者的数据。所有4例确诊患者均患有颅底间变性脑膜瘤并接受了放疗。在所有病例中，皮瓣和供体血管均取自与先前手术不同的部位。未出现诸如脑脊液漏、脑膜炎、伤口感染、伤口出血或皮瓣坏死等并发症。由于发现第一个皮瓣无法存活，难以保留，故将其切除。预防并发症的要点包括在合适的部位固定、对制成的皮瓣进行针刺测试以及采用多层对策预防脑脊液漏。
